Provider Demographics
NPI:1255406252
Name:THOMAS W LEE MD INC
Entity type:Organization
Organization Name:THOMAS W LEE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-946-2277
Mailing Address - Street 1:930 E FOOTHILL BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786
Mailing Address - Country:US
Mailing Address - Phone:909-946-2277
Mailing Address - Fax:909-920-0765
Practice Address - Street 1:930 E FOOTHILL BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786
Practice Address - Country:US
Practice Address - Phone:909-946-2277
Practice Address - Fax:909-920-0765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR 0101740Medicaid
CA1817836OtherPIN
CA1817836OtherPIN
CAGR 0101740Medicaid